PMID: 6988180May 1, 1980Paper

Depression of cardiac output is a mechanism of shunt reduction in the therapy of acute respiratory failure

Chest
D R DantzkerJ G Weg

Abstract

The relationship between changes in cardiac output and intrapulmonary shunt associated with mechanical ventilation was evaluated in 20 patients with the adult respiratory distress syndrome (ARDS). The distribution of ventilation-perfusion (VA/Q) ratios and the level of intrapulmonary shunt was determined by the multiple inert gas technique. Pulmonary blood flow was distributed predominantly to either effective gas-exchanging units or shunt units. Positive end-expiratory pressure (PEEP) or high tidal volume ventilation led to decreases in shunt and cardiac output without altering the overall pattern of VA/Q distributions. Changes in shunt and cardiac output were quantitatively and qualitatively silimar and a strong correlation was found between changes in shunt and cardiac output with both PEEP and high tidal volumes (r = 0.76). Cardiac output depression associated with tese modes of ventilation appears to be a mechanism of shunt reduction in ARDS. Interpretation of improvements in gas exchange in ARDS must take into account concomitant hemodynamic changes.

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Related Concepts

Diastolic Blood Pressure
Cardiac Output
Dioxygen
Positive End-Expiratory Pressure
Pulmonary Circulation
Respiratory Distress Syndrome, Adult
Tidal Volume
Ventilation-Perfusion Ratio

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